What Is Encephalitis?

There are several different causes of encephalitis. The most common is
infection, usually by a virus. The condition can range from mild to
severe, depending on the type of germ producing the infection.
Encephalitis can occur with certain childhood viral illnesses, such as
mumps, measles, varicella (chicken pox), rubella (German measles), or
mononucleosis.

A much more serious type of encephalitis is caused by the herpes simplex
virus
*
(HSV). HSV rarely infects the brain, but when it does, it can be life
threatening. West Nile virus, which first arrived in the United States
from other parts of the world in the late 1990s, can cause encephalitis as
well. Infected birds carry this virus, but mosquitoes can pick up the
virus when they bite infected birds and then spread the virus to humans
through a bite.

Encephalitis may develop in a person who has meningitis (meh-nin-JY-tis),
an inflammation of the membranes surrounding the brain and spinal cord,
called the meninges (meh-NIN-jeez). It also can be a complication of other
infectious diseases, such as rabies, cytomegalovirus
*
infection, listeriosis
*
, syphilis
*
, or Lyme disease. In people with a weakened immune system, for instance,
those with HIV/AIDS, infection by parasites can lead to encephalitis,
especially the parasite that causes toxoplasmosis
*
.

How Common Is Encephalitis?

Each year, several thousand cases of encephalitis are reported to the U.S.
Centers for Disease Control and Prevention. Health officials believe that
many more cases go unreported when the symptoms are mild.

Is the Disease Contagious?

Although the brain inflammation itself is not contagious, viruses that
cause encephalitis may be contagious. When someone contracts the same
virus that a person with encephalitis has, however, it does not mean that
he or she also will develop encephalitis.

*
herpes simplex
(HER-peez SIM-plex)
virus
is a virus that ca n cause infections of the skin, mouth, genitals, and
other parts of the body.

*
cytomegalovirus
(sy-tuh-MEHguh-lo-vy-rus), or CMV, infection is very common and usually
causes no symptoms. It poses little risk for healthy people, but it can
lead to serious illness in people with weak immune systems.

*
listeriosis
(lis-teer-e-O-sis) is a bacterial infection that can cause a form of
meningitis in infants and other symptoms in children and adults.

*
syphilis
(SIH-fih-lis) is a sexually transmitted disease that, if untreated, can
lead to serious lifelong problems throughout the body, including
blindness and paralysis.

*
toxoplasmosis
(tox-o-plaz-MO-sis) is a parasitic infection that usually causes no
symptoms in healthy people, but it can cause serious problems in unborn
babies and people with weak immune systems.

*
mucus
(MYOO-kus) is a thick, slippery substance that lines the insides of
many body parts.

How Is Encephalitis Spread?

Because several different germs can cause encephalitis, spread of the
infection may take place in different ways. For example, mosquitoes
transmit viruses that cause West Nile encephalitis, St. Louis
encephalitis, and western equine encephalitis. Other viruses (such as
herpes simplex virus or varicella-zoster, var-uh-SEH-luh ZOS-ter, virus,
which causes chicken pox) are spread in fluids from the mouth, throat, or
nose; tiny drops of these fluids, such as saliva and nasal mucus
*
, may be sprayed into the air

by a cough or sneeze from someone who is infected. Ticks spread Lyme
disease, and humans can contract rabies from the bite of infected animals,
such as raccoons and bats.

What Are the Signs and Symptoms?

Many people who are infected with a virus that can cause encephalitis have
only mild symptoms. Symptoms in people who develop encephalitis may appear
suddenly and include headache, fever, sensitivity to light, loss of
appetite, and a stiff neck and back. In more serious cases there may be
high fever, nausea (NAW-zee-uh), vomiting, confusion, double vision
*
, personality changes, problems with hearing and speech, hallucinations
*
, sleepiness, clumsiness, muscle weakness, loss of sensation, and
irritability. In the most severe cases, seizures
*
and loss of consciousness may occur. A person who has any of these
symptoms requires immediate medical attention.

*
double vision
is a vision problem in which a person sees two images of a single
object.

*
hallucinations
(ha-loo-sin-AY-shuns) occur when a person sees or hears things that are
not really there. Hallucinations can result from nervous system
abnormalities, mental disorders, or the use of certain drugs.

*
seizures
(SEE-zhurs) are sudden bursts of disorganized electrical activity that
interrupt the normal functioning of the brain, often leading to
uncontrolled movements in the body and sometimes a temporary change in
consciousness.

How Do Doctors Make the Diagnosis?

Doctors use several tests to diagnose encephalitis. Imaging tests, such as
computerized tomography
*
scans or magnetic resonance imaging
*
, provide special views of the brain that allow doctors to check for
swelling,
bleeding, or other abnormalities. An electroencephalogram
(e-lek-tro-en-SEF-a-loh-gram), which measures brain electrical activity,
will show abnormal patterns in a person with encephalitis. Doctors also
might order blood tests to look for the microorganism in the blood and
tests that can tell whether the person's body is producing
antibodies
*
in response to a specific virus or bacterium. A spinal tap, also called a
lumbar puncture, often is performed. In this procedure a needle is
inserted into the lower end of the spine and a small sample of
cerebrospinal (seh-ree-bro-SPY-nuhl) fluid, which surrounds the brain and
spinal cord, is removed. This fluid is examined under a microscope and
tested for signs of infection. In addition, cotton swabs can be used to
take fluid samples from the nose, throat, and rectum
*
to test for certain viruses that might be causing the infection.

How Do Doctors Treat Encephalitis?

Encephalitis is a very serious disease that can be life threatening.
Although very mild cases can be treated at home, it is often necessary for
patients to be hospitalized. Patients usually are admitted to an intensive
care unit, where doctors carefully monitor blood pressure, heart rate, and
ability to breathe. Such patients may require a ventilator
(VEN-tuh-lay-ter), a machine that does the breathing for very ill people
until they can breathe on their own again. Doctors also monitor the body
fluids to help prevent or control swelling of the brain, which can lead to
a dangerous increase in the pressure within the skull.

Several medications may be given to people with encephalitis.
Over-the-counter medicines such as acetaminophen (uh-SEE-teh-MIH-noh-fen)
may be used to treat minor symptoms such as fever and headache. Antiviral
medications sometimes can help prevent the spread of the virus and are
very important in the treatment of encephalitis caused by herpes simplex
virus. If a patient is having seizures, anticonvulsants
*
may help control them. Anti-inflammatory medications called
corticosteroids (kor-tih-ko-STIR-oyds) may lessen swelling in the brain.

How Long Does the Illness Last?

The acute phase of the disease, the time when symptoms are most severe,
usually lasts up to a week. Full recovery can take much longer, often
several weeks or months.

*
computerized tomography
(kom-PYOO-ter-lzed toe-MAH-gruh-fee), or CT, also called computerized
axial tomography (CAT), is a technique in which a machine takes many X
rays of the body to create a three-dimensional picture.

*
antibodies
(AN-tih-bah-deez) are protein molecules produced by the body's
immune system to help fight specific infections caused by
microorganisms, such as bacteria and viruses.

*
rectum
is the final portion of the large intestine, connecting the colon to
the anus.

*
anticonvulsants
(an-tie-kon-VUL-sents) are medications that affect the electrical
activity in the brain and are given to prevent or stop seizures.

*
paralysis
(pah-RAH-luh-sis) is the loss or impairment of the ability to move some
part of the body.

*
coma
(KO-ma) is an unconscious state in which a person cannot be awakened
and cannot move, see, speak, or hear.

What Are the Complications?

Most people recover from encephalitis completely. For some people,
however, swelling of the brain may lead to permanent brain damage. These
patients may face long-term complications, such as learning disabilities,
seizures, speech problems, memory loss, lack of muscle control, paralysis
*
, or coma
*
. In the rare cases where brain damage is severe, death can result.
Infants younger than 1 year and adults older than 55 have the greatest
risk of permanent brain damage and death from encephalitis.

Causes of Encephalitis

Encephaliti s may be caused by a variety of viruses, bacteria, and other
organisms. These agents include:.

Measles, chicken pox, rubella (German measles), mumps, polio, and
other viral illnesses, which generally lead to a mild form of
encephalitis known as postinfectious or para-infctious encephalitis.

Enteroviruses (cn-tuh-ro-VY-ruh-sez), viruses that typically infect
the intestines and then may spread to other parts of the body,
including the brain.

Herpes simplex virus, a virus that can infect the mouth, skin, and
other parts of the body

HIV (human immunodeficiency virus), the virus that causes AIDS
(acquired immunodeficiency syndrome) and is transmitted when an
infected person's blood or b fluids are introduced into the
bloodstream of a healthy person.

Arboviruses (ar-buh-VYruh-sez), which multiply in and are transmitted
by blood-sucking insects (such as ticks and mosquitoes) when they bite
infected birds, rodents (chipmunks and squirrels, for example) and
other small animals and then bite humans.

Animal-borne illnesses, such as rabies, toxoplasmosis, cat scratch
disease, and Lyme disease, that are transmitted to humans by contact
with an infected animal's saliva (through a bite or lick, for
example), contact with an infected animal's feces (FEE-seez, or
bowel movements), or an insect that bites an infected animal and then
bites a person.

How Is Encephalitis Prevented?

Some of the viral infections that can cause encephalitis, including
measles, mumps, and chicken pox, can be prevented with vaccines given in
childhood. To prevent encephalitis caused by West Nile virus or other
viruses transmitted by mosquitoes, people are encouraged to avoid being
outside at dawn and dusk, when mosquitoes are most active. If they do go
out, they are advised to wear light-colored, long-sleeved shirts and long
pants and to use insect repellent. Mosquitoes breed in places where there
is standing water, such as in buckets, birdbaths, and flower pots, so
draining these containers frequently can help control the mosquito
population and decrease the risk of infection.

Resources

Organization

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton
Road, Atlanta, GA 30333. The CDC provides fact sheets and other
information on encephalitis at its website.
Telephone 800-311-3435
http://www.cdc.gov

Website

KidsHealth.org
. KidsHealth is a website created by the medical experts of the Nemours
Foundation and is devoted to issues of children's health. It
contains articles on a variety of health topics, including encephalitis.
http://www.KidsHealth.org

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